Provider Demographics
NPI:1144731795
Name:GREGORY ALAN KUBO, O.D., APC
Entity type:Organization
Organization Name:GREGORY ALAN KUBO, O.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUBO
Authorized Official - Suffix:X
Authorized Official - Credentials:OD
Authorized Official - Phone:714-469-5977
Mailing Address - Street 1:1319 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3001
Mailing Address - Country:US
Mailing Address - Phone:714-525-3330
Mailing Address - Fax:
Practice Address - Street 1:1319 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-3001
Practice Address - Country:US
Practice Address - Phone:714-525-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREGORY ALAN KUBO, O.D., APC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty